ࡱ>  bjbj$$ F|F|Xz<<<4ppphtLDp`777_______$[b e_u<FK/7FKFK_]`MMMFK8<_MFK_MMN\|$]PbK:\_s`0`\eLfe$]e<]7=MeB)F777__hM^777`FKFKFKFKe777777777 : CALIFORNIA STATE UNIVERSITY, LOS ANGELES CHARTER COLLEGE OF EDUCATION DIVISION OF SPECIAL EDUCATION ORIENTATION & MOBILITY SPECIALIST TRAINING PROGRAM APPLICANT AND NEW STUDENT PROCEDURES AND INFORMATION Students admitted to the Orientation and Mobility (O&M) Specialist Training Program must also qualify for admission to the University and the Charter College of Education at CSLA. In conjunction with the Masters Degree Program, students will also complete coursework permitting them to apply for the California Clinical Rehabilitative Services Credential in Orientation and Mobility. Applicants and students in the program must follow the procedures below: Complete the application to the CSLA O&M Specialist Training Program. Have three recommendations (use of the attached Applicant Evaluation forms is preferred, but letters are acceptable) sent directly to the O&M Program Director. Completion of an in-person program interview. Alternative arrangements may be made for out-of-state applicants. Applicants may also be required to complete observations of practicing O&M specialist working with adults and/or children prior to beginning the program. When notified by the O&M Program of admission for training the applicant will need to complete a graduate application for admission to the University. That application should be forwarded directly to the Office of Admissions as soon as possible, unless otherwise directed. (Applicants may apply simultaneously to the O&M Program and the University, but the application fee is not refundable.) NOTE: Two official transcripts from all prior colleges/universities must be sent to the Office of Admissions. In addition, one set of official transcripts must be sent to the O&M Program Director. (Unofficial transcripts can be reviewed by the O&M Program prior to receipt of official transcripts.) TB clearance by verification of an x-ray or tuberculin skin test within the last 12 months is required for registration for classes during the first quarter of study. (While the Registrar will accept a self-read test, a physician or appropriate technician read test will be required for practicum teaching assignments and admission into the Credential Program. For your convenience, a TB clearance form has been attached that can be completed by your personal physician. The test can also be obtained on campus from the Student Health Services for a nominal fee. The completed form should be returned to the O&M office. Applicants are encouraged to maintain copies of all paperwork for their own records. Upon notification of admission to the O&M Program and the University, the new student should contact O&M faculty (323) 343-4411 for information regarding first quarter registration procedures and course selection. Preparation of official credential and M.A. Degree Program forms will be developed during the first week of the program with the guidance of an O&M advisor. An opening day O&M group advisement session will be scheduled. It is the students responsibility to follow-through with all paperwork and to keep on top of all deadlines and procedures. State law requires that all persons teaching in California public schools must demonstrate basic proficiency in reading, writing and mathematics skills by completion of the CBEST test. This requirement does not apply to students pursuing the M.A. Degree only. If there is any possibility that you might wish to work in the public schools in California, it is advisable that you register to take the CBEST as early as possible (even prior to the start of the program). CBEST applications can be obtained in the Student Services Office (KHD2078). University requirements provide that all graduate degree and credential candidates must demonstrate basic writing skills. Students must successfully complete a Writing Proficiency Exam (WPE) or provide evidence of a score of 41 or higher on the writing section of the CBEST during their first quarter of study. Admittance into the CSLA O&M Specialist Training Program is contingent upon acceptance to the University and Masters Degree Program within the Charter College of Education. As part of the O&M Program application you will be completing two similar application pages. These two forms can later be used for application to the Masters Degree and Credential Programs. APPLICATION TO CALIFORNIA STATE UNIVERSITY, LOS ANGELES CHARTER COLLEGE OF EDUCATION ORIENTATION & MOBILITY SPECIALIST RAINING PROGRAM I wish to apply for a traineeship in the CSLA Orientation & Mobility Specialist Training Program. It is my understanding that this traineeship requires four to five quarters of consecutive study leading to a Masters Degree in Special Education- Orientation & Mobility and California Clinical Rehabilitative Services Credential in Orientation & Mobility. If offered admission and should I accept, I declare that it is my intention to meet all program requirements, complete the program, seek employment in this field on a nation basis upon completion of my training and work as an O&M Specialist for a minimum of two full-time equivalent years over the ten year period following graduation. __________________________ Signature of Applicant Date application received by program ________________________ Note: In compliance with Section 504, Rehabilitation Act of 1973, existence of a physical disability shall not preclude consideration for entry into this program. CHARTER COLLEGE OF EDUCATION California State University, Los Angeles Application for Admission MASTERS DEGREE PROGRAM DIVISION OF SPECIAL EDUCATION AND COUNSELING TYPE OR PRINT Name: ___________________________________________________________ SS# ______________________ (Last) (First) (M.I.) List other names which may appear on your records: __________________________________________________ Address _________________________________________, __________________________, _________________ (Street) (City) (Zip Code) Telephone: Home (_____)_______________ Work (_____)_____________ e-mail: _____________________ This Application is for admission to a masters degree program for : Quarter: __________ Year: ______ Program objective: (See listing of available programs on reverse side of page and select only one) Admission Status: _____ Graduate standing at Cal State L.A. _____ Undeclared major or undecided _____ Admitted as post baccalaureate to credential program _____ Transferring from another degree program at CSLA _____ Graduate application to CSLA pending for ______________ Quarter Please Note: Undergraduate students are only eligible for program admission when their degree has been awarded! Degree(s) held: BA _____ BS _____, ______________________________________________________________________________ Major University Date Awarded MA _____ MS _____, ______________________________________________________________________________ Major University Date Awarded List of Credentials held (type and expiration date) ________________________________________________________________________________________________ If you have been admitted to a CSLA credential program, which one are you in? ________________________________________________________________________________________________ Other colleges/universities attended and dates of attendance: _________________________________________________ ________________________________________________________________________________________________ Check any of the following tests you have taken (attach copies of score reports if you have them): CBEST__________ TOEFL __________ WPE __________ I affirm that I own or have ample access to a computer, have an email account, have general knowledge of operation and care of a computer, computer hardware/software, can implement some basic troubleshooting techniques, and have a basic understanding of how to use the internet. ______________________________________________________________ _________________________ Signature of Applicant Date NOTE: This application must be submitted as a complete packet including 3 letters of recommendation and official transcripts to the Division of Special Education and Counseling, Orientation & Mobility Specialist Training Program KH C-1070. Formal admission to the program is contingent upon satisfaction of all admission requirements and filing an approved program plan. Also refer to the Charter College of Education Student Advisement Handbook for Masters Degree Program, and the University General Catalog. MASTERS DEGREE PROGRAMS CHARTER COLLEGE OF EDUCATION Master of Arts in Education: Options in: _____ Bilingual/Multicultural Education in the Elementary Classroom _____ Computer Education and Technology Leadership _____ Curriculum and Instruction in the Urban Elementary School _____ Early Childhood/Primary Education _____ Educational Foundations _____ Mathematics Education _____ Middle and Secondary Curriculum and Instruction Concentrations in: ______ Practice and Action in the Social Context of Middle and Secondary Urban Schools ______ Crosscultural, Language and Academic Development ______ Content Area Specialization ______ Integrating Critical and Reflective Thinking Throughout the Curriculum ______ Language Arts/Literacy ______ Instructional Technology _____ New Media Design and Production _____ Reading _____ Reading and Language Arts Education in the Elementary Classroom _____ Science Education Master of Arts in Educational Administration Options in: _____ Educational Leadership _____ School Business Administration Master of Arts in Special Education: Options in: _____ Autism _____ Early Childhood Education _____ Facilitating Behavior Change _____ Inclusion Facilitator _____ Mild/Moderate Disabilities _____ Moderate/Severe Disabilities _____ Multicultural/Multilingual Special Education _____ Physical and Health Impairments _____ Transition Studies _____ Visual Impairments and Blindness: Teacher Preparation _____ Visual Impairments and Blindness: Orientation and Mobility _____ Master of Arts in Teaching English to Speakers of Other Languages (TESOL) Master of Science in Counseling: Options in: _____ Applied Behavior Analysis _____ School Counseling (School Counseling and Leadership, School Based Family Counseling, or Behavior Intervention Case Management) _____ Marriage, Family and Child Counseling _____ Rehabilitation Counseling _____ School Psychology  CALIFORNIA STATE UNIVERSITY, LOS ANGELES CHARTER COLLEGE OF EDUCATION Application for Admission CREDENTIAL AND CERTIFICATE PROGRAMS Please Type or Print CIN# _________________________ Name:____________________________,______________ SS#_____-_____-_____ Last First Middle List other names that may appear on your records: _______________________________ Address:________________________________________________________________ Street City State ZIP CODE DOB:__________ Primary Language: ___________ Email:____________________________________ Telephone: Home(___)_____________ Work(___)_______________ Cell(___)____________________ Gender:__________ Ethnicity:(Optional)____________ Class Standing: Jr*____ Sr*_____ Grad_____ ************************************************************************************* *Anticipated date of Graduation:___________________ Undergraduate Major:_____________________ Degree(s) Held: (Blended % Urban Learning %) BA___ BS___ ___________________________________________________________________ Major University Date Awarded MA___MS___ __________________________________________________________________ Major University Date Awarded Other:_______ __________________________________________________________________ Degree Major University Date Awarded Other colleges/universities attended and dates of attendance:____________________________________ _____________________________________________________________________________________ Note: You must submit ONE OFFICIAL SET OF TRANSCRIPTS FROM ALL SCHOOLS (excluding Cal State LA) to the Charter College of Education, Office for Student Services. Transcripts from Foreign universities must be evaluated by an approved agency. ************************************************************************************* THIS APPLICATION IS FOR ADMISSION TO A CREDENTIAL/CERTIFICATE PROGRAM: Year:______________ Summer Quarter % Fall Quarter % Winter Quarter % Spring Quarter % CREDENTIAL/CERTIFICATE OBJECTIVE: % Multiple Subject____________________________________________________________________ % Single Subject______________________________________________________________________ (teaching area: i.e., English, Mathematics, Biology, Social Science, Science, Art, Music) % Specialist__________________________________________________________________________ (Reading and Lang. Arts or Adapted P.E.) % Services___________________________________________________________________________ (area: i.e., Preliminary Administrative, School Counseling) % Education Specialist:_________________________________________________________________ (area: i.e., Early Childhood, Mild/Moderate, Moderate Servere, Physical & Health, Visual Impairment) % Clinical Rehabilitative Services________________________________________________________ (area: i.e., Orientation and Mobility) % Certificate_________________________________________________________________________ (area: i.e., Computer Applications, English as a Second Language, Reading) Credential Held_______________________________________________________________________ (area: i.e., Multiple Subject-Preliminary, Single Subject English-Professional Clear) Technology Proficiency: I verify I: Own or have ample access to a computer (example in CSLA computer Labs, or at home or work); 2) Have general knowledge of operation and care of a computer, computer hardware/software, and be able to implement some basic troubleshooting techniques (ex. check connections, restart the computer, etc); 3) Have an email account; and 4) Have a basic understanding of how to use the internet. I understand that it is the expectation that the above skills and their use will be integrated within courses in my credential program(s). All information submitted on this application is tree and correct to the best of my knowledge. Signature: ___________________________________ Date: ___________ Please do not write below this line. OFFICE WORK SHEET ONLY: Psychology req. met: SPCH151 ___ or SPCH150 Math 110: ___ EDFN413 ___ HS(456/457) ___ WPE: _____ Colleges/Universities Attended: ___________________________________________ Calc of Last 90: Term Units Points BA Degree: ____________________ ______________ _____ _____ _____ Date: ___________ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ ______________ _____ _____ _____ CALIFORNIA STATE UNIVERSITY, LOS ANGELES Charter College of Education Name ____________________________________ SID________________________ (Please type) PHILOSOPHY OF EDUCATION STATEMENT Please type a brief personal history. Be certain to include information that relates to your interest in pursuing your current goal and your philosophy of Education. Resources available from federal training grants may vary from year to year. When funds are available, they are distributed equally amongst trainees. Please answer the following questions as accurately as possible. Would you be able to enter this program if funding for tuition and stipends were unavailable? __________________ Do you feel you are in need of financial assistance should program funds be available? ____________________ Give an estimate of how much support you anticipate needing: _____________________ To the best of my knowledge, I meet or will meet at time of entry into the program the following requirements: In order to receive federal funds recipient must be a citizen or national of the U.S. or have permanent resident status. Ability and commitment to complete the required program in consecutive quarters as a full-time student. A Bachelors Degree from an accredited university and have a 2.75 grade point average in the last 90 quarter units or 60 semester units of all university studies (undergraduate and graduate) at the time of admission to the O&M Program. An automobile or alternative reliable form of transportation that will enable the student to do field observations, attend classes, complete practicum assignments and transport students as appropriate. Minimum auto liability insurance of $15,000 personal injury for one, $30,000 injury for two or more, and $5,000 property damage. Ability and willingness to relocate and complete an 11 week internship in Palo Alto, California; Tucson, Arizona, or Tacoma, Washington (typically 3rd or 4th quarter of training in the Spring, Summer, or Fall Quarter. Ability and willingness to attend a one week field trip to the Seeing Eye in New Jersey and other blindness agencies in New York City. Own or have access to a computer (Ex. CSLA computer labs, at home or work, etc.) Have general knowledge of operation and care of a computer, computer hardware/software, and can implement some basic troubleshooting techniques (Ex. Checking connections, restarting the computer etc.) Have an email account (Available through the University, free of charge). Have a basic understanding of how to use the internet. * Resident fees are approximately $2,400 for four quarters. Non-residents pay an additional $8,000-$9,000 in out-of-state fees. ** Applicants with exemplary backgrounds or other special characteristics may be admitted through Special Action Admissions procedures with less than a 2.75 GPA with the approval of the O&M Program Director, the Charter College of Education and the University. REFERENCES: Identify three individuals from whom you will request a reference. Evaluations from supervisors from volunteer or work experience relate to teaching, work with children or adults, or experience with individuals with disabilities are preferred. Other work experience references are acceptable. Three Applicant Evaluation forms are provided for your use. Applications will not be reviewed until all three references have been received. Name Title/Relationship 1. 2. 3. COLLEGE PREPARATION: (List most recent preparation first.) Institution Major/Minor Year(s) Degree GPA     WORK EXPERIENCE: (List most recent experience first.) (Dates) From/To Position Employer/Agency Supervisor Phone      How did you first hear about our O&M Specialist Training Program? Why do you wish to enter this Program? Are you applying to other O&M Programs? _____ If so, which Programs? Describe any experience that you have had with blind or visually impaired individuals and/or other individuals with disabilities. Identify any courses taken in the area of visual impairment and/or special education. Briefly describe the course content. Do you have a preference for working with children adults, elderly, or individuals with multiple disabilities? ___ If so, which and why? Do you have any initial preference for working in a specific geographic location after completion of training? ___ If so, where and why? To what extent are you limited to jobs in your preference area? In the space provided below or on separate sheet(s), write an essay responding to the following: We are interested in learning more about you as an individual. Describe the strengths, qualities and experiences that you possess that would make you successful in this program and as a future O&M Specialist. Include a brief discussion of your career objectives and how you expect that this degree program will prepare you to attain those objectives. SUPPLEMENTAL QUESTIONS FOR INDIVIDUALS WITH T.V.I. CREDENTIAL PURSUING DUAL CERTIFICATION IN O&M, ONLY: Why are you interested in obtaining dual certification? To what degree is your current employer supportive of your pursuit of dual certification? Circle all that apply: Highly Encouraging Encouraging Discouraging Required for Current Position Unaware of your interest Willing to provide flexible scheduling to meet coursework and practicum needs Identify which of the following pertain to you: _____ I have a Masters Degree and Clinical Rehabilitative Services Credential in O&M and wish to obtain a teaching credential in visual impairment. _____ I have a teaching credential in visual impairment and wish to obtain a Masters Degree and Clinical Rehabilitative Services Credential in O&M. ____ I have a teaching credential in visual impairment and a Masters Degree in Special Education and wish to obtain a Clinical Rehabilitative Services Credential. ____ Other, please specify Describe the strengths and weaknesses in your prior training specific to visual impairment and blindness. On the basis of your past experiences in working with blind and visually impaired individuals, describe strategies that have made you a successful professional in the field. Identify two professional areas in which you feel the need or desire to improve our abilities to effectively serve blind and visually impaired individuals. CALIFORNIA STATE UNIVERSITY, LOS ANGELES ORIENTATION & MOBILITY SPECIALIST TRAINING PROGRAM APPLICANT EVALUATION Applicant Name_______________________ How long have you known this individual? ______ In what capacity? _______________________________________________________________ Approximately how many contact hours per day, week, or month? ________________________ EXCELLENTABOVE AVG.AVERAGEBELOW AVG.POORNO MEANS FOR EVAL Ease with which person grasps new information, concepts and task.  Demonstrates imagination and creativity in dealing with task.  Demonstrates ability to seek solutions to problems and makes judgments without need for direction from supervision  Attitude of person in using constructive criticism.  Ability of persons to express own ideas and opinions  Demonstrates ease in dealing with new situations and people.  Demonstrates ability to follow through and complete assigned tasks and responsibilities.  Demonstrates an ability to take logically based vs. emotionally- based approach to disputes.  Freedom from negative attitudes towards others based upon differences in culture, abilities, etc. Ability to use common sense in problem solving.  Ability to develop and maintain good relationships with: subordinates  peers  supervisors Provide any constructive criticism that you could make to help this individual improve his or her performance in dealing with others or in doing the work in which you observed him or her: Describe any special strengths this person has which you would emphasize beyond the above ratings: Other comments: _________________________________ ________________________ Evaluators Signature Date _________________________________ Evaluators Name (PRINT) _________________________________ Evaluators Title Please return this form to: Projector Director, Orientation & Mobility Specialist Training Program Charter College of Education Division of Special Education California State University, Los Angeles 5151 State University Drive Los Angeles, CA 90032 Note: This recommendation is not confidential and is open to access by the student concerned in accordance with the Family Education Rights and Privacy Act of 1974. CALIFORNIA STATE UNIVERSITY, LOS ANGELES ORIENTATION & MOBILITY SPECIALIST TRAINING PROGRAM APPLICANT EVALUATION Applicant Name_______________________ How long have you known this individual? ______ In what capacity? _______________________________________________________________ Approximately how many contact hours per day, week, or month? ________________________ EXCELLENTABOVE AVG.AVERAGEBELOW AVG.POORNO MEANS FOR EVAL Ease with which person grasps new information, concepts and task.  Demonstrates imagination and creativity in dealing with task.  Demonstrates ability to seek solutions to problems and makes judgments without need for direction from supervision  Attitude of person in using constructive criticism.  Ability of persons to express own ideas and opinions  Demonstrates ease in dealing with new situations and people.  Demonstrates ability to follow through and complete assigned tasks and responsibilities.  Demonstrates an ability to take logically based vs. emotionally- based approach to disputes.  Freedom from negative attitudes towards others based upon differences in culture, abilities, etc. Ability to use common sense in problem solving.  Ability to develop and maintain good relationships with: subordinates  peers  supervisors Provide any constructive criticism that you could make to help this individual improve his or her performance in dealing with others or in doing the work in which you observed him or her: Describe any special strengths this person has which you would emphasize beyond the above ratings: Other comments: _________________________________ ________________________ Evaluators Signature Date _________________________________ Evaluators Name (PRINT) _________________________________ Evaluators Title Please return this form to: Projector Director, Orientation & Mobility Specialist Training Program Charter College of Education Division of Special Education California State University, Los Angeles 5151 State University Drive Los Angeles, CA 90032 Note: This recommendation is not confidential and is open to access by the student concerned in accordance with the Family Education Rights and Privacy Act of 1974. CALIFORNIA STATE UNIVERSITY, LOS ANGELES ORIENTATION & MOBILITY SPECIALIST TRAINING PROGRAM APPLICANT EVALUATION Applicant Name_______________________ How long have you known this individual? ______ In what capacity? _______________________________________________________________ Approximately how many contact hours per day, week, or month? ________________________ EXCELLENTABOVE AVG.AVERAGEBELOW AVG.POORNO MEANS FOR EVAL Ease with which person grasps new information, concepts and task.  Demonstrates imagination and creativity in dealing with task.  Demonstrates ability to seek solutions to problems and makes judgments without need for direction from supervision  Attitude of person in using constructive criticism.  Ability of persons to express own ideas and opinions  Demonstrates ease in dealing with new situations and people.  Demonstrates ability to follow through and complete assigned tasks and responsibilities.  Demonstrates an ability to take logically based vs. emotionally- based approach to disputes.  Freedom from negative attitudes towards others based upon differences in culture, abilities, etc. Ability to use common sense in problem solving.  Ability to develop and maintain good relationships with: subordinates  peers  supervisors Provide any constructive criticism that you could make to help this individual improve his or her performance in dealing with others or in doing the work in which you observed him or her: Describe any special strengths this person has which you would emphasize beyond the above ratings: Other comments: _________________________________ ________________________ Evaluators Signature Date _________________________________ Evaluators Name (PRINT) _________________________________ Evaluators Title Please return this form to: Projector Director, Orientation & Mobility Specialist Training Program Charter College of Education Division of Special Education California State University, Los Angeles 5151 State University Drive Los Angeles, CA 90032 Note: This recommendation is not confidential and is open to access by the student concerned in accordance with the Family Education Rights and Privacy Act of 1974. 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An X-Ray of the lungs was taken and found to be negative on ____________________ __________________________________ Date Signature OR An intradermal tuberculosis skin test was given and found to be negative. _____________________ __________________________________ Date Signature NAME OF APPLICANT ________________________________ PFN: __________________ Social Security Number: ______________ ______________________________________ __________________________________ Name of Physician (PRINT) or Technician Signature ____________________________________________________________________________ Address of Physician City Zip License Number _____________________________________ Date     FOR OFFICE USE ONLY Last 90 GPA _______ CSLA GPA __________ Class. 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